1. Line of Duty Determinations (LOD) NGB/SGPS

2. Always On Mission Overview  Purpose of LOD  Eligibility  Additional Requirements  Types of LODs  National Guard Bureau (NGB) LOD Determination Board  Line of Duty Care  Episode of Care  References

3. Always On Mission Purpose  The purpose of a LOD determination is to determine :  whether illness, injury or disease existed prior to service (EPTS) and if EPTS condition was aggravated by military service  whether or not the illness, injury, disease or death occurred while the member was absent without authority  whether or not the illness, injury, disease or death was due to the member’s misconduct.

4. Always On Mission Purpose  For ARC members, LOD determinations are used to establish, manage, and authorize healthcare.  Entitlements associated with a LOD:  Authorized Medical Care  Medical Continuation Orders (MEDCON)  Incapacitation Pay (INCAP)

5. Always On Mission Eligibility  Who is eligible:  On published orders for any period of time, or while on inactive duty; or  Traveling directly to or from the place the member performs active duty or training or while staying overnight immediately before and between consecutive IDT periods.

6. Always On Mission Eligibility  Members are covered Saturday and Sunday during drill weekend  Members are covered who are outside the commuting distance and travel on Friday to area where drill is performed  Coverage ends Sunday night- member takes direct route home  Any deviation from direct route is not covered  Any incident that occurs after returning home from drill is not covered

7. Always On Mission Additional Requirements  Members must report condition within 72 hours to commander and Guard Medical Unit (GMU) (para 2.2.1)  Failure to report requires a written explanation to CC and GMU  Must provide initial medical documentation within 5 workdays of incident  Members who fail to report any condition 180 days after end of orders (or IDT) are presumed fit for duty. The only avenue for addressing issues is VA (para 1.7.4)  Special circumstances may be covered if the 180 days has lapsed, e.g. latent onset symptoms of PTSD (DoDI 1241.01).

8. Always On Mission Types of LODs  Administrative LOD  Informal LOD  Formal LOD

9. Always On Mission Administrative LOD  Documented on SF 600 or in electronic medical record  A military medical provider can make an administrative determination of “in the Line of Duty” if there is no need for continuing care and treatment, or requests for MEDCON or INCAP.  The injury or illness is simple, such as a sprain, contusion or minor fracture, and is not likely to result in permanent disability.  For ARC, the medical provider may make an administrative determination to document a minor condition as ILOD if there is no likelihood of permanent disability, hospitalization or requirement for continuing medical treatment.  If an administrative determination is made, no further action is required.

10. Always On Mission Informal LOD  Documented on AF Form 348  Accomplish when:  Requires continuing medical care or treatment beyond the period of duty during which the condition was incurred or aggravated.  The member requires hospitalization. Note: Visits to the Emergency Room or minor outpatient procedures alone do not constitute hospitalization.  A request for MEDCON or INCAP is initiated

11. Always On Mission AF Form 348  Filling out the AF Form 348  Blocks 11 and 12  Symptoms and diagnosis  Details of illness, injury, disease  A separate AF 348 must be completed for multiple conditions unless they are linked to a single event

12. Always On Mission Formal LOD  Initiated on AF 348 and finalized on DD Form 261  Accomplished when:  Under strange or doubtful circumstances or;  Under circumstances commander believes should be fully investigated

13. Always On Mission NGB LOD Determination Board  The LOD determination board is a “reviewing authority” for both Informal and Formal LODs. The Board consist of NGB SG, JA and A1.  LODs that require higher review:  All death cases (informal or formal)  Misconduct, alcohol or drugs, sexual assault, suicide attempts/gestures/ideation, self-mutilation  All formal LODs  Questionable cases that Wing Commander wishes to be reviewed  Any disease process  Mental health related conditions are considered disease processes (ex: PTSD, Depression, Anxiety, etc.)  LOD determinations are not considered finalized until the approving authority makes a determination.

14. Always On Mission Line of Duty Care  Military Treatment Facility (MTF)  Defense Health Agency (DHA – formerly MMSO)  Defense Health Agency, Great Lakes (1-888-647-6676)  Forms: http://www.tricare.mil/Resources/Forms/DHA-GL http://www.tricare.mil/Resources/Forms/DHA-GL  Gives pre-authorization for civilian medical care  Authorizes payment of civilian medical claims  Collaborates with unit representatives regarding line-of duty (LOD) care for remotely located service members  Veteran’s Administration (VA) – file claim

15. Always On Mission Episode of care  Episode of Care  Member is entitled to only episode of care for the identified In the Line of Duty condition – period of care and treatment until member is returned to duty w/o restriction or returned to duty or separated by the DES  Members who are not entered into IDES within one year (365 days) of diagnosis may lose their entitlement to care in accordance with DODI 1241.01 Reserve component (RC) Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay Entitlements.  Care for LOD conditions is NOT open-ended or indefinite – LOD IS CONSIDERED CLOSED!!!!!!!!!!!!  Interim LOD  Only valid for 55 days

16. Always On Mission References AFI 36-2910 AFI 41-210 DoDI 1241.01

17. Always On Mission Line of Duty Determinations (LOD) Questions ?